Outcomes Research Consortium, Cleveland, Ohio, USA.
Department of Anesthesiology, University of California San Diego, San Diego, California, USA.
Expert Rev Med Devices. 2021 Jun;18(6):533-543. doi: 10.1080/17434440.2021.1927705. Epub 2021 May 17.
Conventional nerve blocks utilize local anesthetic drugs to provide pain relief for hours or days following surgery or trauma. However, postoperative and trauma pain can last weeks or months. Ultrasound-guided percutaneous cryoneurolysis is an anesthetic modality that offers substantially longer pain relief compared to local anesthetic-based nerve blocks. In this review, we discuss the history, mechanism of action, and use of ultrasound-guided percutaneous cryoneurolysis by anesthesiologists in the setting of acute pain management. Ultrasound-guided percutaneous cryoneurolysis offers the potential to provide weeks or months of pain relief following surgery or trauma. Compared to continuous local anesthetic-based peripheral nerve blocks, currently the gold standard for providing long duration postoperative analgesia, cryoneurolysis has benefits that include: 1) longer duration measured in weeks or months rather than days; 2) no external reservoir of local anesthetic to be carried by the patient; 3) no risk of infection; and 4) no risk of catheter dislodgement. However, cryoneurolysis can induce a prolonged motor block in addition to the sensory block, decreasing the appropriate indications to those in which potential sensory and motor deficits are acceptable. Additionally, cryoneurolysis of multiple nerves can have a substantial time requirement relative to conventional nerve blocks.
传统的神经阻滞利用局部麻醉药物在手术或创伤后数小时或数天内提供疼痛缓解。然而,术后和创伤性疼痛可能持续数周或数月。超声引导经皮冷冻神经松解术是一种麻醉方式,与基于局部麻醉的神经阻滞相比,提供的疼痛缓解时间显著延长。在这篇综述中,我们讨论了麻醉师在急性疼痛管理中使用超声引导经皮冷冻神经松解术的历史、作用机制和用途。超声引导经皮冷冻神经松解术有可能在手术后或创伤后提供数周或数月的疼痛缓解。与目前提供长时间术后镇痛的金标准连续局部麻醉药外周神经阻滞相比,冷冻神经松解术具有以下优点:1)以周或月而不是天来衡量的持续时间更长;2)患者无需携带局部麻醉药的外部储液器;3)无感染风险;4)无导管移位风险。然而,冷冻神经松解术除了感觉阻滞外还会引起长时间的运动阻滞,从而将适当的适应证缩小到那些可以接受潜在感觉和运动缺陷的患者。此外,与传统的神经阻滞相比,冷冻神经松解术对多个神经的操作需要相当长的时间。
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